Klotz H P, Buchmann P
Klinik für Viszeralchirurgie, Departement Chirurgie, Universitätsspital Zürich.
Helv Chir Acta. 1993 Sep;60(1-2):287-9.
The common therapy for trans- and intersphincteric fistula usually is opening the fistula tract. Healing and rough continence thereafter is uneventful, but when follow-up is intensified and patient are asked for slight soiling and discharge many minor complaints become evident. Therefore we started a series of patients suffering from inter-, trans-, extrasphincteric or supralevatoric fistula with an advancement flap procedure after excision of the fistula, without dissection of any muscle fibre. Up to now 23 patients were operated including 5 with Crohn's disease. 17/23 were healed primarily and 6/23 failed to heal with 5 successful reoperations. 4/5 Crohn's patients operated during quiescent disease are healed. No discharge or soiling was reported after a follow-up time from 5 months to almost 2 years. In conclusion advancement flap gives best results in respect to continence. The flap should include not only mucosa but underlying internal sphincter muscle fibres too.
经括约肌和括约肌间瘘管的常见治疗方法通常是打开瘘管通道。此后愈合及粗略的控便情况平稳，但当加强随访并询问患者有无轻微便污和分泌物时，许多轻微不适就变得明显了。因此，我们对一系列患有括约肌间、经括约肌、括约肌外或提肌上瘘管的患者，在切除瘘管后采用推进皮瓣手术，且不解剖任何肌纤维。到目前为止，已对23例患者进行了手术，其中5例患有克罗恩病。23例中有17例一期愈合，6例未愈合，5例再次手术成功。5例克罗恩病患者在病情静止期接受手术，4例愈合。随访时间从5个月到近2年，未报告有分泌物或便污情况。总之，就控便而言，推进皮瓣手术效果最佳。皮瓣不仅应包括黏膜，还应包括其下的内括约肌肌纤维。
